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1.
Artigo em Chinês | MEDLINE | ID: mdl-32086916

RESUMO

Objective:The aim of this study is to evaluate the efficacy of endoscopic surgery and conventional surgery combined with radiotherapy in the treatment of Neuroblastoma. Method:Forty-three patients with olfactory neuroblastoma undergoing surgery combined with radiotherapy were retrospectively analyzed. The patients were divided into endoscopic surgery and conventional surgery. All patients received postoperative radiotherapy at a dose of 60-70 Gy, the 5-year survival rate and local recurrence time of the two groups were compared, and the therapeutic effects of endoscopic surgery and traditional surgery were compared. Result:Through survival analysis, the 5-year overall survival rates of the traditional surgery group and the endoscopic surgery group were 50% and 58% (P=0.560), the local recurrence rates were 44% and 48% (P=0.288), and the mean recurrence time was 5.6 months and 12.5 months (P=0.032). Conclusion:There was no difference between endoscopic surgery and conventional surgery combined with radiotherapy in the treatment of Neuroblastoma, and the time of local recurrence was significantly prolonged. In early Neuroblastoma, endoscopic sinus surgery may be superior to open surgery in terms of efficacy and patient survival.


Assuntos
Estesioneuroblastoma Olfatório/radioterapia , Estesioneuroblastoma Olfatório/cirurgia , Neoplasias Nasais/radioterapia , Neoplasias Nasais/cirurgia , Terapia Combinada , Humanos , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos
2.
World Neurosurg ; 132: e116-e123, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518738

RESUMO

OBJECTIVE: Anterior craniovertebral junction (CVJ) surgery has continued to be one of the most debated neurosurgical topics. The transoral approach (TOA) has been considered the choice for this region. However, it has some limitations and a not negligible degree of surgery-related morbidity. With the advent of endoscopy, the endoscopic endonasal approach (EEA) was developed, which minimized morbidity and improved exposure. To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not been performed and no definitive consensus has been reached on the indications for both approaches. METHODS: We compared the TOA and EEA to the CVJ using the previously described operability score (OS), calculated at 4 different targets: the C1 tubercle (C1), the lowest exposed point of the odontoid process (C2), the basion (BS) and the middle clivus (MC). The higher the OS for the selected targets, the more favorable the approach. RESULTS: The TOA had higher OSs at the MC, C1, and C2 targets, and the EEA showed greater OSs at MC and C1. The TOA and EEA had similar OSs at the BS. These results have shown that the OS is more favorable at C1-C2 using the TOA and the OSs at the MC and BS were similar. CONCLUSIONS: The OS is an effective method to compare surgical approaches. The present study demonstrated the maximal exposure capability of the 2 approaches. The TOA seemed to be superior for lower targets and the EEA for upper targets. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach.


Assuntos
Articulação Atlantoaxial/anatomia & histologia , Articulação Atlantoaxial/cirurgia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/cirurgia , Endoscopia/métodos , Boca/anatomia & histologia , Boca/cirurgia , Cavidade Nasal/anatomia & histologia , Cavidade Nasal/cirurgia , Base do Crânio/anatomia & histologia , Base do Crânio/cirurgia , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/cirurgia , Cadáver , Humanos
3.
BMJ Case Rep ; 12(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31377721

RESUMO

A 40-year-old female patient presented to ears, nose and throat complaining of cacosmia and discharge from the left maxillary sinus. Her CT scan revealed an ectopic supplemental nasal tooth which could not be removed by nasoendoscopy. Therefore, a conventional intraoral surgical approach was taken. In this case, we discuss the indications for conventional surgical removal of teeth from the nasal cavity when a nasoendoscopic approach is not possible. We highlight the potential pitfalls of both conventional and nasoendoscopic approaches, including some essential considerations when treatment planning these cases.


Assuntos
Cavidade Nasal/cirurgia , Dente Supranumerário/cirurgia , Adulto , Feminino , Humanos , Cavidade Nasal/diagnóstico por imagem , Transtornos do Olfato/etiologia , Tomografia Computadorizada por Raios X , Extração Dentária , Dente Supranumerário/diagnóstico por imagem , Resultado do Tratamento
4.
Int J Pediatr Otorhinolaryngol ; 126: 109608, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31374389

RESUMO

OBJECTIVES: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress that is difficult to treat. The primary objective of this study was to identify factors that predict the need for initial and revision surgery for CNAPS. The secondary objective is to identify risk factors in maternal history associated with the development of CNPAS. METHODS: Infants with CNPAS between 2010 and 2017 were identified by ICD- 9 and 10 codes. Demographics, maternal history, anatomic features on imaging and medical and/or surgical management were reviewed. Frequencies, means and standard deviations were calculated. A p-value <.05 was considered significant. RESULTS: Twenty infants were included. All underwent flexible nasal endoscopy with inability to pass the scope in either nostril in 65% of infants. Nineteen had a CT scan and 13 had a MRI with midline defects in 76.3% and 53.8%, respectively. Solitary central mega-incisor was present in 65%. Half underwent surgical intervention at a mean age of 74.8 days, with 90% requiring revision surgery. There was no difference in pyriform aperture distance in the surgical and non-surgical patient subgroups (5.4 mm and 5.2 mm, p = .6 respectively). No specific variables were predictive of need for initial or revision surgery. Maternal diabetes mellitus (MDM) was found in 55% of mothers of infants with CNPAS. CONCLUSION: Pyriform aperture distance was not a predictor of surgical intervention. MRI should be considered in all infants with CNPAS as the rate of intracranial complications is high. MDM may be a risk factor for CNPAS.


Assuntos
Cavidade Nasal/anormalidades , Obstrução Nasal/congênito , Adolescente , Adulto , Diabetes Gestacional , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Obstrução Nasal/diagnóstico por imagem , Obstrução Nasal/terapia , Gravidez , Gravidez em Diabéticas , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
Artigo em Chinês | MEDLINE | ID: mdl-31434375

RESUMO

Objective: To investigate the effect of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with nasal obstruction. Methods: Thirty-two OSAHS patients with nasal obstruction hospitalized from January 2017 to January 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital Affiliated to Anhui Medical University were selected, with 28 males and 4 females, aged 40.3±8.5 years old (x±s), and treated with individualized nasal cavity ventilation expansion techniques. Nasal acoustic reflex and resistance examination, polysomnography (PSG) monitoring were performed before and three months after operation. Nasal obstruction symptom evaluation (NOSE) and Quebec sleep questionnaire (QSQ) were completed as well. The nasal acoustic reflex, nasal resistance, NOSE, QSQ score, apnea hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO(2)) before and after operation were compared and analyzed. SPSS 22.0 software was used for statistical analysis. Results: After the operation, the total nasal resistance and total score of NOSE scale of patients decreased significantly as well as the total score of QSQ scale increased significantly ((0.140±0.043) kPa·s/L vs (0.277±0.067) kPa·s/L, 9.84±4.11 vs 53.00±11.57, 5.67±0.43 vs 3.86±0.46, t value was 10.687, 18.035, -16.904, respectively, all P<0.05), and the scores of five dimensions increased in varying degrees. Among the indexes of PSG, there was no significant difference in AHI and LSaO(2) values before and after operation, but AHI decreased and LSaO(2) increased. Conclusion: Nasal cavity ventilation expansion techniques can effectively alleviate the symptoms of nasal obstruction in OSAHS patients and improve their sleep and quality of life.


Assuntos
Cavidade Nasal/cirurgia , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Apneia Obstrutiva do Sono/cirurgia , Adulto , Técnicas de Diagnóstico do Sistema Respiratório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico , Polissonografia , Qualidade de Vida , Reflexo Acústico , Apneia Obstrutiva do Sono/diagnóstico
6.
World Neurosurg ; 132: e722-e731, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421301

RESUMO

BACKGROUND: Prediction of visual outcome after endoscopic endonasal tumor resection still remains a challenge. We investigated the prognostic value of the preoperative peripapillary retinal nerve fiber layer (pRNFL) using optical coherence tomography for visual outcome after endoscopic endonasal surgery (EES) for suprasellar tumors. METHODS: We retrospectively analyzed 122 patients who underwent EES for sellar and suprasellar tumors between January 2016 and January 2018. We retrospectively analyzed the pre- and postoperative relationship between pRNFL thickness and visual outcome based on visual acuity (visual acuity score) and visual field (mean deviation [MD]). RESULTS: Preoperatively, 216 eyes (mean global pRNFL thickness, 94.3 ± 12.4 µm; 88.5%) were included in the normal pRNFL group (≥70 µm) and 28 eyes (mean global pRNFL thickness, 54.3 ± 11.0 µm; 11.5%) were included in the thin pRNFL group (<70 µm). There was a very strong correlation between pre- and postoperative pRNFL thickness (r = 0.930). The thin pRNFL group showed a stronger correlation between pre- and postoperative MDs than the normal pRNFL group (r = 0.619 and r = 0.420, respectively; P < 0.01). Multivariate analyses identified pRNFL thickness as the only significant predictor of postoperative visual acuity (odds ratio [OR], 25.02; 95% confidence interval [CI], 7.68-81.50; P < 0.01) and visual field (OR, 39.46; 95% CI, 10.39-149.83; P < 0.01). CONCLUSIONS: Preoperative pRNFL thickness plays a prognostic value in postoperative visual outcome after EES for sellar and suprasellar tumors. Patients with pRNFL thickness ≥70 µm before surgery are more likely to improve visual outcome than those with thickness <70 µm.


Assuntos
Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Neurônios Retinianos/patologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
7.
J Craniofac Surg ; 30(8): 2483-2485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469737

RESUMO

OBJECTIVE: The authors aimed to determine the changes in the odor threshold and sinonasal outcome test-22 scores of the patients after septoplasty surgery in terms of nasal septum deviation classifications. METHODS: Forty-nine patients with nasal septum deviation, aged between 17 and 65, were included in our study. The sinonasal outcome test-22 scores questionnaire and the N-Butanol Threshold test were administered to the patients, 2 days before and 2 months after the septoplasty. RESULTS: The authors' study had 4 major findings: Odor threshold scores improved after septoplasty operation both for the narrower and the wider side of the nasal airway passage. The Vidigal classification for nasal septum deviation was best for predicting the changes for odor threshold scores after septoplasty operation. The nasal septum deviation in which the nasal septum was pushing the inferior turbinate to lateral nasal wall caused the most smell dysfunction according to the Vidigal classification. Unilateral vertical crest affecting the nasal valv area or the posterior part of the septum had the most negative effect on olfactory functions according to the Mladina classification. CONCLUSION: Septoplasty operation leads to improvement in odor threshold scores, and the Vidigal nasal septum deviation classification was best in predicting postoperative odor threshold changes.


Assuntos
Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Odorantes/análise , Rinoplastia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Deformidades Adquiridas Nasais/fisiopatologia , Período Pós-Operatório , Rinoplastia/efeitos adversos , Olfato , Inquéritos e Questionários , Adulto Jovem
8.
World Neurosurg ; 132: e802-e811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31404693

RESUMO

OBJECTIVE: Surgical treatment of large and giant pituitary adenomas is challenging and associated with higher risk of complications and lower rate of gross total resection. We present our experience with surgical management of large and giant adenomas using the extended endoscopic transsphenoidal approach (EETA). METHODS: A total of 80 patients with large (30-39 mm) and giant (≥40 mm) pituitary adenomas who underwent tumor resection using EETA were studied. Radiologic data, hormonal and visual status, surgical outcomes, complications, and factors affecting the extent of resection were evaluated. RESULTS: Forty-five tumors (56.3%) were classified as large and 35 (43.8%) as giant adenomas. Gross total resection was achieved in 66 patients (82.5%), near-total resection in 10 (12.5%), and subtotal resection in 4 (5%). Preoperative factors including larger tumor size, multilobular shape of tumor, and higher Knosp scores significantly decrease the likelihood of gross total resection. Of patients with preoperative visual acuity impairment and visual field deficit, 76.8% and 74.1%, respectively, experienced improvement after surgery. The most common complications include new pituitary insufficiency (16.4%), permanent diabetes insipidus (7.5%), and cerebrospinal fluid leakage (5%). Two cases of meningitis (2.5%) and 3 deaths (3.8%) occurred in this cohort of patients. Mean follow-up duration was 24.2 months. CONCLUSIONS: EETA can be a safe and efficient approach as the first-line treatment of patients with large and giant pituitary adenomas and is associated with high rates of gross total resection or near-total resection, visual function improvement, and a relatively low rate of complications.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Oriente Médio , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Osso Esfenoide/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Transtornos da Visão/etiologia , Adulto Jovem
9.
J Otolaryngol Head Neck Surg ; 48(1): 30, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277707

RESUMO

INTRODUCTION: Ectopic sinonasal teeth are uncommon. The classic approach to removal of such foreign bodies was the Caldwell-Luc. In recent years however, endoscopic approaches have become increasingly utilized. Despite this, there is a dearth of literature and consensus regarding the endoscopic removal of ectopic sinonasal teeth. As such, we conducted a systematic review on all cases of endoscopic removal of ectopic sinonasal teeth in the literature. With an understanding of the literature, clinical and technical decision making for patients with this pathology may be elucidated. METHODS: Systematic review of the Ovid Medline, EMBASE Classic and Pubmed databases were conducted using PRISMA guidelines. RESULTS: Our search identified 100 articles. Final inclusion consisted of 23 studies with a total of 27 patient cases. The majority of the patients included were male (70.4%) with a mean age of 27.06 years. Patients presented with a multitude of symptoms, with nasal obstruction (48.14%), rhinorrhea (22.2%), facial pain (22.2%) and epistaxis (22.2%) being most common. Surgeons mostly reported using a 0° endoscope (22.2%) and performing a maxillary antrostomy/uncinectomy (37%) and simple extraction under general anesthetic (41%). CONCLUSIONS: This systematic review analyzed important epidemiological, clinical and technical information regarding patients with endoscopic removal of sinonasal ectopic teeth. Further research is needed to promote implementation of such data into clinical practice.


Assuntos
Endoscopia , Seio Maxilar/cirurgia , Cavidade Nasal/cirurgia , Doenças dos Seios Paranasais/cirurgia , Erupção Ectópica de Dente/cirurgia , Adulto , Feminino , Humanos , Masculino , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Sinusite/etiologia , Sinusite/cirurgia , Erupção Ectópica de Dente/complicações
10.
J Laryngol Otol ; 133(6): 501-507, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31271349

RESUMO

OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem Tridimensional , Órbita/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Adulto , Fatores Etários , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Órbita/diagnóstico por imagem , Órbita/patologia , Medição da Dor , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
11.
J Craniofac Surg ; 30(8): 2445-2448, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274820

RESUMO

OBJECTIVE: In this study, the authors aimed to compare the nasal physiology and nasal cavity volume with three-dimensional computed tomography (3D-CT) 1 year after the operation with the values before the operation to investigate the possible narrowing and loss of function in the nasal cavity after septorhinoplasty (SRP) operation. METHODS: Of 415 patients who had a primary SRP operation, 28 patients who met the criteria were included in the study. Nasal cavity volumes of patients with postoperative CTs were measured three-dimensionally after a mean 13 months, and objective rhinologic measurements (rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow [PNIF]) and subjective assessment methods (Visual Analog Scale [VAS], Nasal Obstruction Symptom Evaluation [NOSE]) were performed. RESULTS: The mean postoperative VAS and PNIF values of the patients were significantly higher than the mean preoperative values. The mean postoperative NOSE value of the patients was significantly lower than the mean preoperative values. Although the mean MCA-1 and MCA-2 levels of the patients increased postoperatively, the increase was not significant. Although the postoperative mean values of VOL-1 and VOL-2 increased compared with the preoperative values, the increase was not significant. In the CT measurements of the patients, the nasal cavity volumes were significantly higher than the preoperative values. CONCLUSION: Nasal cavity volumes in patients undergoing SRP were compared with 3D-CT for the first time in the literature, and a significant increase in nasal volume was observed in the postoperative first year. This finding suggests that the correction of intranasal problems leads to an increase in the nasal volume in SRP operations, although nasal osteotomy is performed.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Cavidade Nasal/diagnóstico por imagem , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Cavidade Nasal/fisiologia , Cavidade Nasal/cirurgia , Obstrução Nasal/cirurgia , Período Pós-Operatório , Rinomanometria , Rinometria Acústica , Rinoplastia/métodos , Escala Visual Analógica , Adulto Jovem
12.
J Craniofac Surg ; 30(7): 1990-1993, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31205277

RESUMO

Palatal fistulae represent a pathological connection from the oral cavity through the hard or soft palate to the nasal cavity and can present a significant reconstructive dilemma. Surgical correction of palatal fistulae is often limited by prior treatment, including ablative procedures and radiotherapy, or previous reconstructive attempts. In light of these challenges, the nasoseptal flap represents an excellent adjacent source of vascularized tissue which may be suitable for palatal fistula repair with minimal donor site morbidity, low associated risks, and a short recovery period. The purpose of this study was to fully understand the potential utility of this reconstructive option, including the ability to harvest a composite flap including both septal cartilage and contralateral mucoperichondrium. In this single institution prospective study consisting of a series of 5 cadaver dissections, primary outcome measures were the anterior reach of the flap as compared to the anterior nasal spine and the size of the palatal defect that the nasoseptal flap could be used to successfully reconstruct. Composite flaps were successfully harvested in continuity with a disc of septal cartilage and contralateral mucoperichondrium, providing structural integrity to the reconstruction and the ability to anchor the flap to the native hard palate mucosa. The nasoseptal flap's maximum anterior reach was within 2.0 cm (standard deviation of 0.1 cm) from the anterior nasal spine and could reliably reconstruct palate defects of 2.5 cm or less. The nasoseptal flap provides a viable regional option for reconstructing defects of the hard palate. Prospective clinical trials are needed to investigate long-term reconstructive and functional outcomes of the composite nasoseptal flap in palatal reconstruction.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Cadáver , Fissura Palatina/cirurgia , Dissecação , Feminino , Humanos , Masculino , Cavidade Nasal/cirurgia , Nariz/cirurgia , Palato Mole/cirurgia , Estudos Prospectivos
13.
Radiat Oncol ; 14(1): 107, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196122

RESUMO

BACKGROUND: There is a scarcity of data about the prognostic value of orbital invasion in esthesioneuroblastoma (ENB), as well as about its management strategies. Indications for the preservation of orbital contents remain controversial, and the evaluation of orbital invasion has been ill defined. METHODS: This retrospective analysis contained 60 ENB patients with orbital invasion who underwent radiotherapy with or without surgery over the past 14 years. Orbital invasion was classified into three grades. RESULTS: There were 52 patients at stage C and 8 at stage D, according to Foote classifications. Grade I, grade II and grade III orbital invasion was detected in 12, 23, and 25 patients, respectively. The median follow-up was 57 months (IQR 32-95 months). Fourteen patients received radical radiotherapy, with a 5-year overall survival (OS) of 63.5%; 46 received surgery plus radiation, with a 5-year OS of 70.7%; and the difference was not statistically significant (p = 0.847). Orbital preservation was feasible in 100% of cases, including 18 cases that extended to extraocular muscles or the eye globe. Five-year locoregional relapse-free survival was 100% in patients with prophylactic elective neck irradiation (PENI) and 58.1% in patients without PENI (p = 0.004). Univariate analysis showed that grade II/III orbital invasion was associated with poorer OS and progression-free survival. Neck metastasis (with a Foote stage of D) was independently associated with shorter OS and distant metastasis-free survival in multivariate analysis. CONCLUSIONS: Our data suggested that primary radiotherapy achieved comparable survival to surgery plus radiotherapy in advanced ENB. Invasion of either the extraocular muscles or the eye globe is not a contraindication for eye-sparing surgery. Orbital invasion in grade II/III was significantly associated with adverse survival outcomes. Prophylactic radiotherapy to the neck with N0 significantly reduces the risk of regional recurrence.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Estesioneuroblastoma Olfatório/terapia , Cavidade Nasal/efeitos da radiação , Cavidade Nasal/cirurgia , Neoplasias Nasais/terapia , Neoplasias Orbitárias/terapia , Radioterapia de Intensidade Modulada/métodos , Adulto , Idoso , Terapia Combinada , Estesioneuroblastoma Olfatório/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Nasais/patologia , Neoplasias Orbitárias/patologia , Órgãos em Risco/efeitos da radiação , Prognóstico , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
14.
World Neurosurg ; 128: e409-e416, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31042605

RESUMO

BACKGROUND: Endoscopic endonasal anterior skull base malignant sinonasal tumor resection and reconstruction remains a challenge. We describe our septal flip flap (SFF) reconstruction, a new surgical technique for repairing anterior skull base defects and report our outcomes. METHODS: We retrospectively reviewed the clinical data of 24 patients who underwent skull base reconstruction using a SFF following endoscopic resection with transnasal craniectomy. We raise the SFF from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries; the SFF is then rotated laterally for anterior skull base reconstruction after transnasal resection with craniectomy. RESULTS: The SFF was used for multiple tumor types including, most commonly, intestinal-type adenocarcinoma, followed by olfactory neuroblastoma, squamous cell carcinoma, sinonasal undifferentiated carcinoma, and other types. All of the cases had either preoperative or postoperative radiation therapy. All flaps remained viable postoperatively. Postoperatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. CONCLUSIONS: The SFF adds to the clinical armamentarium the opportunity to provide vascularized mucosal coverage extending from the frontal recess back to the planum sphenoidalis. The use of SFF requires careful consideration when dealing with paranasal sinus cancers so as not to infringe oncologic principles.


Assuntos
Septo Nasal/cirurgia , Neoplasias Nasais/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adenocarcinoma/cirurgia , Adolescente , Adulto , Idoso , Carcinoma/cirurgia , Craniotomia/métodos , Estesioneuroblastoma Olfatório/cirurgia , Feminino , Humanos , Masculino , Neoplasias do Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroendoscopia/métodos , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Adulto Jovem
15.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142481

RESUMO

Pyogenic granuloma gravidarum is a benign fibrovascular proliferative lesion usually involving the oral gingivae in pregnant patients. While it also occurs, although less frequently, on other oral sites such as lips, tongue and palate, it is relatively unusual to find it in the nasal cavity. Furthermore, lesions normally involute spontaneously after childbirth. For persistent lesions requiring surgical management, imaging has historically been limited to CT. This case is notable not only for its uncommon location but also for its recurrent nature, failure to regress post partum and the use of MRI in the preoperative planning.


Assuntos
Granuloma Piogênico/cirurgia , Cavidade Nasal/cirurgia , Doenças Nasais/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Epistaxe/etiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Planejamento de Assistência ao Paciente , Gravidez , Cuidados Pré-Operatórios/métodos , Recidiva , Tomografia Computadorizada por Raios X
16.
J Orthop Surg Res ; 14(1): 119, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060590

RESUMO

BACKGROUND: To investigate the efficacy and safety of endoscopic transnasal anterior release and posterior reduction without odontoidectomy to treat irreducible atlantoaxial dislocation (IAAD). METHODS: A series of 9 patients with IAAD underwent endoscopic transnasal anterior release and posterior reduction without odontoidectomy. Etiology, instrumentation, fusion rate, and complications were documented. All patients were assessed clinically and radiologically for neurological recovery using the Japanese Orthopedic Association (JOA) score, atlantodontoid interval (ADI), and cervicomedullary angle (CMA). RESULTS: The mean age of the patients was 41.6 years, ranging from 14 to 60 years. Pathology showed os odontoideum in 3 patients, old traumatic dens fracture in 3 patients, occipitalization of C1 in 2 patients, and rheumatoid arthritis in 1 patient. Seven patients underwent C1-C2 pedicle screw fixations, and 2 patients required occipitocervical fixation. Eight cases resulted in complete reduction and 1 in partial reduction. Complications included one superficial infection related to the posterior approach. All patients were followed up for an average of 17 (range 13-32) months. Bony fusion was confirmed in all cases under radiologic assessment at 1 year postoperatively, and the bony fusion rate reached 100%. Moreover, no instrumental failure occurred during the entire follow-up period. The JOA score improved from 7.21 ± 1.62 to 12.28 ± 0.81 at the last follow-up. The ADI of 9 cases was 7.06 ± 0.85 mm preoperatively, which decreased to 2.26 ± 0.56 mm at the final follow-up. CMA improved from 103.80° ± 4.16° to 143.23° ± 7.47° postoperatively. CONCLUSION: With transnasal approach and lack of odontoidectomy, this method could not only treat IAAD safely and effectively, but also reduce the possibility of many complications associated with the traditional transoral approach and odontoidectomy.


Assuntos
Articulação Atlantoaxial/cirurgia , Endoscopia/métodos , Luxações Articulares/cirurgia , Cavidade Nasal/cirurgia , Processo Odontoide/cirurgia , Adolescente , Adulto , Articulação Atlantoaxial/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Processo Odontoide/diagnóstico por imagem , Adulto Jovem
17.
J Craniofac Surg ; 30(6): 1724-1729, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31022131

RESUMO

BACKGROUND: Radical resections of ethmoidal tumors with intracranial extension present highly complex surgical and reconstructive problems. The purpose of report is to describe the authors' use of adipofascial radial forearm free flaps following unsuccessful anterior cranial fossa oncological surgery. METHODS: Adipofascial radial forearm free flaps were used to treat 3 similar cases of cutaneous fistula following bone resorption with communication to anterior cranial fossa and nasal cavity. RESULTS: No flap loss, no deaths, and no postoperative complications were observed. All patients underwent a nasal endoscopy, revealing adequate vitality and integration of the free flaps. One of the patients consented to additional surgery to improve outcome. CONCLUSIONS: Meticulous preoperative selection and an experienced interdisciplinary team are required to achieve the best surgical outcomes in complex cases. Free adipofascial forearm flaps could be an excellent therapeutic option in the reconstruction of the anterior skull base, notably in cases involving major postoperative complications.


Assuntos
Neoplasias Encefálicas/cirurgia , Fossa Craniana Anterior/cirurgia , Complicações Pós-Operatórias , Prosencéfalo/cirurgia , Adulto , Idoso , Feminino , Antebraço/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Neuroendoscopia , Procedimentos Cirúrgicos Reconstrutivos
18.
J Craniofac Surg ; 30(8): 2355-2357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022141

RESUMO

OBJECTIVE: To introduce a novel cartilage trap-door flap technique in endonasal septoplasty to correct high dorsal deviation of the cartilaginous septum, and confirm its effectiveness. DESIGN: Prospective observational study. SETTING: Medical center. METHODS: 46 patients who had underwent septoplasty using the cartilage island flap technique to correct the high dorsal deviation from November 2014 to November 2015. The subjective symptoms were measured using the Nasal Obstruction Symptom Evaluation scale. The objective evaluations of the surgical results were analyzed using acoustic rhinometry. Post-operative status of the nasal septum was estimated by nasal endoscopic examination. RESULTS: Among 46 patients, 32 cases (69.57%) were "complete correction", 14cases (30.43%) were "improved" with residual deviation and there was not "no-change" or "even worse" case based on endoscopic examination. Minimal cross-sectional area in convex side of nasal cavity was significantly changed from 0.22cm to 0.56cm after the surgery, and nasal volume in narrower side of nasal cavity was significantly changed from 2.44mL to 6.22 mL. The patients' nasal obstruction symptoms significantly reduced from 10.43 before the surgery to 1.45 after the surgery. During the follow-up period, the authors have not experienced any obvious complications such as saddle nose, septal perforation, and bleeding. CONCLUSION: The proposed cartilage trap-door flap technique provides easy and effective results for dorsal deviations of the cartilaginous septum in selected cases without significant complications.


Assuntos
Cartilagem/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Deformidades Adquiridas Nasais/complicações , Estudos Prospectivos , Rinometria Acústica , Rinoplastia/métodos , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento , Adulto Jovem
19.
J Laryngol Otol ; 133(6): 538-541, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006394

RESUMO

OBJECTIVE: To discuss the reasons for misdiagnosis of supernumerary nasal teeth. METHODS: Clinical data of four supernumerary nasal tooth patients were analysed retrospectively at visits to our otolaryngology department between 2005 and 2018. RESULTS: All four patients were male and had a supernumerary nasal tooth in the right nasal cavity. Three of the four patients had previously been misdiagnosed. All the supernumerary nasal teeth were surrounded by granulation tissue or hypertrophic nasal mucosa, and were subsequently confirmed by computed tomography and endoscopy. The granulation tissue or hypertrophic nasal mucosa was removed using microwave ablation, and the supernumerary nasal teeth successfully removed by endoscopy. CONCLUSION: Supernumerary nasal teeth are rare, and are usually misdiagnosed because such teeth are surrounded by hypertrophic nasal mucosa or granulation tissue. They can be confirmed by computed tomography and endoscopy.


Assuntos
Endoscopia/métodos , Tecido de Granulação/cirurgia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Dente Supranumerário/diagnóstico por imagem , Dente Supranumerário/cirurgia , Adolescente , Adulto , Seguimentos , Tecido de Granulação/diagnóstico por imagem , Humanos , Masculino , Cavidade Nasal/patologia , Mucosa Nasal/patologia , Mucosa Nasal/cirurgia , Estudos Retrospectivos , Medição de Risco , Amostragem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 127: 221, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30974272

RESUMO

Surgery for anterior cranial base lesions is challenging because tumors often spread from their origin to sinuses, orbits, and middle cranial fossa, resulting in risky surgeries.1,2 To approach such complex diseases, recently combined multiportal approaches have been proposed.3,4 At the best of our knowledge, operative application of a combined endoscopic endonasal and transcranial surgery for complex anterior cranial base lesions has not been described. Therefore a surgical video of such an approach is presented. A 37-year-old woman affected by a huge recurrence of a tuberculum meningioma extended to right orbit presented to our department, complaining of right ocular bulb dislocation with multidirectional limitations in eye movements (Video 1). Given the complexity and localization of the lesion, a combined endoscopic endonasal-transcranial surgery was performed. Such a combined approach, although demanding in terms of the presence of both otolaryngologist and neurosurgeon during the surgery, also requires strong synergy among them and permits them to control anterior cranial base lesions from both specialists' perspectives, simultaneously. In this case, while an endonasal corridor permitted an accurate excision of ethmoidal and medial orbital wall part of the lesion, a bicoronal approach allowed the aggression of the anterior cranial base portion of the tumor, allowing good control of cranial base neurovascular structures, eventually obtaining a gross total resection, without perioperative complications. Furthermore, a combined multiportal approach allows cooperative strategies among the surgeons involved, leading to safer, quicker, and more effective resections with less brain retraction, given the wide angles of views to the lesion that a multiportal approach can offer.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Terapia Combinada , Feminino , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem
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